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Home My WebLink AboutMiscellaneous - 299 BLUE RIDGE ROAD 4/30/20189 0 co POSox55098 I Boston, MA 02205-5G98 617-951-0600 Form of Notice of Casuafty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall N ANDOVER, MA 0 1845 N ANDOVER, MA 0 1845 RE: Insured: THOMAS KIN'NEMAN and KAREN POUSHT ER Property Address: 299 BLUE RIDGE RD, N ANDOVER, MA Policy Number: HMA 0095998 Claim Number: BOS00056942 Date of Loss: 3/23/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chqpter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chqpter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Eric Yablonski Claim Examiner 3/24/2015 Safety Insurance Company Homeowners Claims Unit P. 0. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3550 Fax: (617) 531-6650 Email: EricYablonski@Safetylnsurance.com "t Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 003?) BOARD OF FIRE PREVENTION REGULATIONS Date issued: APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORAM TION) Date: 4/11/11 City or Town of- North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 299 Blue Ridge Rd Map: Lot: Owner or Tenant Tom Kinneman Owner's Address Is this permit in conjunction with a building permit? Yes 0 No [:] Purpose of Building Residence Existing Service Amps —Volts New Service Amps Volts Telephone No. 978-258-6814 (Check Appropriate Box) Utility Authorization No. Overhead Undgrd F] Overhead UndgrdF] Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: wiring of screen porch No. of Meters No. of Meters Completion of the followinjz table may be waived bV the Inspector of Wires. No. of Recessed Fixtures 5 No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above o In 1:11 No. of Emergency Lighting grnd. grnd. Battery Units No. of Receptacle Outlets 4 No. of Oil Burners FIRE ALAMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers m Heat Pu p I Jo�n� .......... JKW F ....................... No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local [] Municipal [I Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: I No. of Devices or Equivalent OTHER: Reconnection of washer & dryer unit Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $920.00 (When required by municipal policy.) Work to Start: 4/11 /11 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licen- see provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuip�office. CHECK ONE: INSURANCE Z BONDE] OTHER [-] (Specify:) I certify, under thepains andpenalties ofperjuiy, that the informatiopIq FIRM NAME: Electric Services, Inc Licensee: Robert J. Branca gnatu Si at, I *Per M.G.L. c. 147, s. 57-61, security work requires Depa en�tof Public� (If applicable, enter "exempt" in the license number line) Z Address: 19 Dale St, Andover, MA ZiD: 01 10 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have signature below, I hereby waive this requirement. I am the (check one) El owner Owner/Agent Signature Phone: Ah, application is true and complete. LIC. NO.: 14302 LIC. NO.:— LIC.NO.: S: Bus. Tel. No.: 978-475-4995 Alt. Tel. No.: 978-423-8350 the liability insurance coverage normally required by law. By my owner's agent. $ ad Aiauioj SIdduall :ajoM :PgSOID ;)Iu(jjlllujaa — 13V uolsualxa JIU1.14(l n :pasojo alucvIgana — 8 'zj0z'gjjsn,3nVVnojtp_2ui aolxopuu .P SYz'gj �sngnv uo.Wuivai90q poriod OuTf rrenb oql 2ujln'p,,00uojsixa lo pogg uf,, su/,ilieiRluAoiddejolluuodAuu'o4upuoi.lBlrdxoolq,eoildduosimioqlosl!puosoqsigaAinojioj'spuo4xc)XIIL,oI It'UrOma JOV 011 'SuOildom PQJIU�j iglIA -4iodoid I-eajjo luomdolomp 4o osn oqj gutuimoo sosmoil puu quuad umpoo ol uolsu.01xg JuDf,-Inoj OpBuiolnig ua 3ufqsijqi3jso Xq osodind si sjgqvnjloVuoisua:�xE[IjuijgdotgpuLSigAOOQ.IOI ouooauuol-!?uolpuLif4moi2qofolouioido�si4o-esi* ul ipjoosodlndoqj-Zj0ZjosjoV6ip JO 8CZ-TQldl3qDJ0 9L Pug ft suopooS Sqp2puoin pue 010Zjo sloVoqljo OpZ,gl ruqDjo -ELI uo!lo2S Sq ppm sum 13V uotsuajxa Ilmlaa gql wipailddu jpuod mp uo polvis f4ilug gufllulsul OIN 10 'QuA'O DIR lgippjo isanboi w4pm mg uodn popuiuml oq lluqs Ilumd V -osnuo olquosuar jqj poll!awd oq Iluiqs )lJoAijO Uol , 'uOilbloildh poldtHoo, i0j 0mlljo UOTSUQIxg UL . . U014!m u0clfj -poliod iguoui-ZI 2m 000id zip 2uunp possol2oid jou seq io paouounuoo ;ou sEq 31,oa pgzu q)nL, QIR IBLR poumuolop sEq oqs io P 0 ------oTjrp!laxurpue-pouopui3qe smi jo-jo400dsuroqj-Xq-p*wgo0-oq Am puu 'fqAT OV U0110"SUOD 9UT02UO-jo gual olp 01 su pollum oq7lluqs silmad W .4 .1 opou vp ioj olqlsuodsai oq 1pqs f4lluo qonS -uoi or RB RE Iddii I!uuod otp uo poluls uopiodioo jo uuTj tosiod oia ol ponssi oq Iltqs ;!uugd luoT 001.3 ug 'ZE § '991 'o ll'.D 'vj ol Imnsind pg;Moddu soiT jo jologdsul ue Xq poldoom uooq seq UOT Of .A p? Iddu j!uijod u jo)jV -auoj poqposold oqj uo pojgoqHuqssuoi OTiddiapue'qllTaoAiuoulLu000tpinoVnolqlauoj!unoqlluils2uu Joum iluisuijoc)oiouoplAoidoluu0juOT1730TIddL7;!uuod .18 Im RE 9 9 Ing § 0071 LTS slugmP UO IUV apoa sll;;snq3ussuj/v ZIOZ a '-/-/3 - /,,, Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... y .......... FZ-e 1-2— . . .......................... has permission to perform ......... ................. wiring in the building of .............. ............................ at. .... 2Y q.. 65�:.(167 ..... ka),?,f . . ....... e6 ....... . North Andover, Mass. Pee .... Lic. No..J.qAn.Z ............. i ... �i- L4 RICAL NSPECrOR Check #-TI702-f Date. . .7 ...... Y-- 314 . 0- 4z TOWN OF NORTH ANDOVER . PERMIT FOR GAS INSTALLATION This certifies that ... 5�IAA.0�� has permission for gas installation \,C. H ................... in the buildings of 1. � �'t ir � � , ........................ at . ........ North Andover, Mass. Fee. Lic. No.. dASINSPECTOR Check# 6 03' 2 January 17,2014 Ms. Karen Poushter 299 Blue Ridge Road North Andover, MA 01845 Dear Ms. Poushter: G)Ium� Ga 'so of Massachusetts A NiSource Company 995 Belmont Street Brockton, MA 02301 During a recent visit, our service technician detected a safety problem with your gas heating system located at 299 Blue Ridge Rd., North Andover, MA 01845 — house heater emiting carbon monoxide. Accordingly, we have issued a Warning Tag because of this situation. Under the circumstances, we strongly urge you to correct the code violation. In addition, the Massachusetts code pertaining to the installation of gas appliances and gas piping, established under Chapter 737, Acts of 1960, requires that the condition be remedied. If you have any question, please call our Service Department at 1-800-677-5052 and ask to speak with the Service Supervisor. Please disregard this notice if the condition has been corrected. Sincerely, Customer Service Department Columbia Gas of Massachusetts MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) AVA71( Mass. Date S-03-2007 Permit # "". Building Location_4V , P,266' Ayb Owner's Name Owner Tel# Type of Occupancy New 0 Renovation I-] ReplacementCgf., PlanSubmitted: Yes 11 NoK, FIXTURES Installing Company Name STARK & CRONK PLUMBING & HEATING 308 MAIN STREET, GROVELAND, MA 01834 Address Business Telephone # 978-372-6981 Name of Licensed Plumber or Gas Fitter Check one.- Certificate 19 Corporation 2486C C1 Partnership 11 Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes )t No 0 If you have checked y�s, please indicate the type coverage by checking the appropriate box. A liability insurance policy )Q Other type of indemnity o Bond o OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: C)wnpr F-1 Am�nt r-1 Signature of Owner or Owner's Agent I hereby certify that all of the details and infor(hation I have submitted (or entered) knowledge and that all plumbing work and installations performed under the permit pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the By. City/Town APPROVED (OFFICE USE ONLY) Type of License: -Plumber -Gas fitter -Master -Journeyman nd accurate to the best of my be in compliance with all of Licensed Pluffitef-Q;-13as Fitter License Number 11027 1 0 1ST FLOOR Mal Installing Company Name STARK & CRONK PLUMBING & HEATING 308 MAIN STREET, GROVELAND, MA 01834 Address Business Telephone # 978-372-6981 Name of Licensed Plumber or Gas Fitter Check one.- Certificate 19 Corporation 2486C C1 Partnership 11 Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes )t No 0 If you have checked y�s, please indicate the type coverage by checking the appropriate box. A liability insurance policy )Q Other type of indemnity o Bond o OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: C)wnpr F-1 Am�nt r-1 Signature of Owner or Owner's Agent I hereby certify that all of the details and infor(hation I have submitted (or entered) knowledge and that all plumbing work and installations performed under the permit pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the By. City/Town APPROVED (OFFICE USE ONLY) Type of License: -Plumber -Gas fitter -Master -Journeyman nd accurate to the best of my be in compliance with all of Licensed Pluffitef-Q;-13as Fitter License Number 11027 R V .4 0 m V 74 4 0 0 0 0 4 -4 2 0 m In m I z r V fit Cl) -4 Z; z CA X